Elevateher360 Program application form

WITU has partnered with the 10X program to scale its ElevateHer360, a digital economy-focused program aimed at equipping young women, aged 18 to 35, with the digital skills and personalized mentorship needed to succeed in today's digital economy job market. Through partnerships with employers, the program connects participants to work opportunities, while also supporting some graduates in establishing themselves in the gig economy or launching their own startups.

By filling out this form, you consent to Women in Technology Uganda (WITU) using your information, along with its partners, solely for the implementation of the program. All shared information will remain confidential.

Name *
First and last name
Email *
Phone number *
Date of birth *
MM
/
DD
/
YYYY
Gender *
Address  *
Level of education *
 Which course(s) are you interested in? *
Required
Which device will you be using for the course? *
Required
Have you attended an online course before? *
Are you in any form of employment? *
If you selected yes, choose the industry you are in?
If you selected others, specify
Under which work arrangement? *
What is your current income per month? (Ugshs) *
Do you have any experience running a business? *
If you answered yes, which business?
What type of digital work would you be looking to get into? *
Required
If you selected others, please specify
What motivates you to join the program?
If you selected Others, please specify 
If selected, are you available to attend classes and assessments in your district for 2-4 hours every day for 5 days a week for 3 months?
Clear selection
NEXT OF KIN 
Full names *
Phone number *
What's your relationship to them *
How did you hear about the program? *
If you selected others, please specify
would you like to recommend  other women for this program? 
 *
What is their email or phone number 
Do you have any form of disability? *
If you selected yes, please specify

If you answered "Yes," please specify the assistive technology you require to successfully participate in the program.

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Women In Technology Uganda.

Does this form look suspicious? Report

Google Forms